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Abstract BackgroundResearch on the 1918 influenza pandemic often focuses exclusively on pandemic years, reducing the potential long‐term insights about the pandemic. It is critical to frame the 1918 pandemic within the underlying population dynamics, health, and sociocultural context to understand what factors contributed to pandemic mortality and survivorship, with respect to observed inequality, and consequences of the pandemic. Materials & MethodsIndividual death records and censuses from The Rooms Provincial Archives and Memorial University of Newfoundland Digital Archives for three major causes of death—influenza and pneumonia; tuberculosis; and pooled bronchitis, measles, and whooping cough—were collected for three periods in the early 20th century: pre‐pandemic (1909–11), pandemic (March 1918–Janaury 1919), and post‐pandemic (1933–1935). We calculated pooled age‐standardized mortality rates and changes in pre‐ to post‐pandemic mortality rates by region. We fit Kaplan–Meier and Cox proportional hazards models to each period, controlling for age, cause of death, and region. ResultsPandemic mortality was higher than that of pre‐ and post‐pandemic periods. Post‐pandemic mortality was significantly lower than pre‐pandemic mortality in all regions, except Western Newfoundland. Survival was lowest during the pandemic and increased significantly post‐pandemic (p < 0.0001), with no significant differences among regions during the pandemic (p = 0.32). Significant differences in survivorship in 1933–1935 were driven by increasing differences in survivorship for P&I among the regions more than other causes of death. DiscussionMyopic perspectives of pandemics can obscure our understanding of observed outcomes. Inequalities in respiratory disease mortality are evident in pre‐ and post‐pandemic periods, but these would have been missed in investigations of the pandemic period alone. 

Abstract ObjectivesThe selective mortality hypothesis of tuberculosis after the 1918 influenza pandemic, laid out by Noymer and colleagues, suggests that acute exposure or pre‐existing infection with tuberculosis (TB) increased the probability of pneumonia and influenza (P&I) mortality during the 1918 influenza pandemic, leading to a hastened decline of TB mortality in post‐pandemic years. This study describes cultural determinants of the post‐pandemic TB mortality patterns in Newfoundland and evaluates whether there is support for this observation. Materials and methodsDeath records and historical documents from the Provincial Archives of Newfoundland and Labrador were used to calculate age‐standardized island‐wide and sex‐based TB mortality, as well as region‐level TB mortality, for 1900–1939. The Joinpoint Regression Program (version 4.8.0.1) was used to estimate statistically significant changes in mortality rates. ResultsIsland‐wide, females had consistently higher TB mortality for the duration of the study period and a significant shift to lower TB mortality beginning in 1928. There was no similar predicted significant decline for males. On the regional level, no models predicted a significant decline after the 1918 influenza pandemic, except for the West, where significant decline was predicted in the late‐1930s. DiscussionAlthough there was no significant decline in TB mortality observed immediately post‐pandemic, as has been shown for other Western nations, the female post‐pandemic pattern suggests a decline much later. The general lack of significant decrease in TB mortality rate is likely due to Newfoundland's poor nutrition and lack of centralized healthcare rather than a biological interaction between P&I and TB. 

Anthropologists recognize the importance of conceptualizing health in the context of the mutually evolving nature of biology and culture through the biocultural approach, but biocultural anthropological perspectives of infectious diseases and their impacts on humans (and vice versa) through time are relatively underrepresented. Tuberculosis (TB) has been a constant companion of humans for thousands of years and has heavily influenced population health in almost every phase of cultural and demographic evolution. TB in human populations has been dramatically influenced by behavior, demographic and epidemiological shifts, and other comorbidities through history. This paper critically discusses TB and some of its major comorbidities through history within a biocultural framework to show how transitions in human demography and culture affected the disease-scape of TB. In doing so, I address the potential synthesis of biocultural and epidemiological transition theory to better comprehend the mutual evolution of infectious diseases and humans. 

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